In vitro fertilization (IVF) is an advanced reproductive technique in which fertilization occurs outside of the body, in a laboratory. The first successful IVF procedure took place in England in 1978. Since that time, more than five million babies have been born worldwide using IVF.
An IVF cycle begins by having the patient take injectable fertility medications to produce multiple eggs during one cycle. The microscopic eggs that are produced and matured during the cycle grow inside of fluid collections in the ovaries called follicles. We are able to see the follicles clearly by ultrasound. During stimulation of the ovaries with fertility medications, the patient will undergo frequent ultrasound examinations and or/blood tests to monitor the growing follicles and rising blood estrogen levels. The monitoring phase of the IVF cycle takes approximately 8-12 days. When the eggs are mature, the patient will undergo an egg retrieval procedure.
On the day of embryo transfer, the embryos will be graded based on their cell growth and development. This grading system, along with the patient’s age, will help the physician and patient to decide on the appropriate number of embryos to transfer.
The egg retrieval takes place in a procedure room that is adjacent to the embryology laboratory. The patient will receive a light anesthetic, and will sleep during the procedure. The eggs are retrieved by placing a needle through the vaginal wall, and into the ovary. The eggs are suctioned from the growing follicles and collected in test tubes. Next, the test tubes are passed to the waiting embryologist.
Once the eggs are in the laboratory they will be visualized under a microscope, and they will be prepared for fertilization with either fresh or frozen sperm. The eggs and sperm will be placed together in a petri dish and set into an incubator overnight. Sometimes, special fertilization techniques (see section on Intracytoplasmic Sperm Injection – ICSI) will be required. The following morning, the embryologist will be able to determine how many embryos have formed.
The embryos will typically spend 2-5 days in the laboratory before they are ready to be transferred back to the uterus. Some patients will choose to test embryos for genetic or chromosome abnormalities (see sections on Preimplantation Genetic Screening) prior to embryo transfer. On the day of embryo transfer, the embryos will be graded based on their cell growth and development. This grading system, along with the patient’s age, will help the physician and patient to decide on the appropriate number of embryos to transfer.
An embryo transfer procedure is done while the patient is awake, and feels similar to a pap smear. To start, the cervix is visualized and cleaned. Then a very thin catheter (tube) loaded with the embryo(s) is placed gently through the cervix and into the uterine cavity. The embryo(s) are placed near the top of the uterus using ultrasound guidance. Following embryo transfer, the patient is asked to rest for a short period of time before returning home. Approximately ten days after the transfer, a blood pregnancy test (hCG level) is performed to determine if the patient is pregnant.
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